EP2166963B1 - Appareil médical pour traiter le corps d'un être humain ou d'un animal avec des ondes de pression ou des ondes de choc mécaniques - Google Patents

Appareil médical pour traiter le corps d'un être humain ou d'un animal avec des ondes de pression ou des ondes de choc mécaniques Download PDF

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Publication number
EP2166963B1
EP2166963B1 EP08758527.9A EP08758527A EP2166963B1 EP 2166963 B1 EP2166963 B1 EP 2166963B1 EP 08758527 A EP08758527 A EP 08758527A EP 2166963 B1 EP2166963 B1 EP 2166963B1
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EP
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Prior art keywords
applicator
waves
impact
shock waves
applicator part
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EP08758527.9A
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German (de)
English (en)
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EP2166963A2 (fr
Inventor
Gerold Heine
Klaus M. IRION
Ernst H. Marlinghaus
Manfred Schulz
Pavel Novak
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Storz Medical AG
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Storz Medical AG
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22004—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1697—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans specially adapted for wire insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A61B17/921—Impactors or extractors, e.g. for removing intramedullary devices for intramedullary devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/203—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser applying laser energy to the outside of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/009—Auxiliary devices making contact with the eyeball and coupling in laser light, e.g. goniolenses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/328—Applying electric currents by contact electrodes alternating or intermittent currents for improving the appearance of the skin, e.g. facial toning or wrinkle treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/225—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves
    • A61B17/2251—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves characterised by coupling elements between the apparatus, e.g. shock wave apparatus or locating means, and the patient, e.g. details of bags, pressure control of bag on patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8802—Equipment for handling bone cement or other fluid fillers
    • A61B17/8847—Equipment for handling bone cement or other fluid fillers for removing cement from a bone cavity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00544—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated pneumatically
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A61B2017/922—Devices for impaction, impact element
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A61B2017/922—Devices for impaction, impact element
    • A61B2017/924—Impact element driving means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B2018/1807—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using light other than laser radiation

Definitions

  • the invention relates to a medical device for the treatment of the human or animal body with mechanical pressure or shock waves, with a device for generating the pressure or shock waves having at least one applicator, which for generating the pressure or shock waves on a proximal side with Bumps can be acted upon and coupled on a distal side of the pressure or shock waves in the body.
  • Such a device is from the document DE 197 25 477 C2 known.
  • treatment of the human or animal body is, for example, the treatment of soft tissue, in particular for pain therapy, the treatment of bone tissue, the destruction of body stones, the removal of plaque in vessels, the treatment of the teeth, but also that Removing bone cement or driving in bone nails or wires to understand.
  • the known device has as an apparatus for generating the pressure or shock waves on an applicator, which is acted upon by a periodically movable impact member with shocks.
  • the impact part is moved back and forth along an acceleration path, wherein the impact part is moved by means of a pneumatic drive between a proximal starting position and a distal end position in which the impact part rebounds against the applicator part.
  • the pressure waves or shock waves generated by the applicator part develop a mechanical pressure or shock wave effect after being coupled into the body in the body area to be treated.
  • the document DE 198 59 553 C1 discloses a therapy device having an acoustic axis source for generating acoustic waves traveling in a focus located on the acoustic axis.
  • the source points Means for generating light which emit a focused light beam of visible light with at least substantially parallel beam path, which coincides at least substantially with the acoustic axis of the source and makes them visible.
  • the document EP 1 163 882 A1 discloses an apparatus for removing body stones with an intracorporeal lithotripter having a hollow metal sonotrode that is excited to rock vibration by an electrically driven ultrasonic transducer for stone fragmentation.
  • the device is switchable to a reversible drive of a percussion part, with which a mass body of an additionally provided shock probe, a periodic impact force is applied to generate a formation of pressure or shock waves in the shock probe and thus to obtain an alternative option for the Steinzertrümm réelle ,
  • the document US 4,821,729 discloses an apparatus and method for non-invasive fragmentation of body stones.
  • the device has, in addition to the source for generating shockwaves, an ultrasound transducer for verifying the position of the focus of the shockwaves.
  • the document DE 197 40 825 A1 discloses a device for generating tubular channels in muscle tissue, with which independently of one another the conversion of the tubular channel can be specifically thermally influenced and, at the same time, shockwave-like pressure amplitudes can be generated in the environment of the conversion.
  • the device has helically wound electrodes, which can be generated by applying high voltage pulses to the electrodes by sparking shock or pressure waves.
  • the document WO 94/17771 A2 discloses a device for pain therapy and / or for influencing the autonomic nervous system.
  • the device has a pressure pulse source and an ultrasonic locating device.
  • US 4,727,875 discloses a device for crushing stones in the body, wherein shock waves are generated by means of a striker drive, and wherein an additional ultrasonic location is provided in the treatment area.
  • the present invention has the object, a device of the type mentioned in such a way that the effect of pressure or shock waves in the human body, in particular the therapeutic effect on tissue, is further improved.
  • the device according to the invention thus differs from the known device in that not only the mechanical effect of the pressure or shock waves is deployed in the body area to be treated, but at least an additional effect based on electricity, light and / or ultrasound. Also, a further mechanical effect parameter can be generated beyond the pressure and shock waves and coupled into the body, as will be described later.
  • the invention is based on the finding that the effect of mechanical pressure or shock waves can be improved if the body area to be treated, for example soft tissue, is acted upon by current, light and / or ultrasound, which, for example, the therapeutic mechanical pressure or shock wave effect Increased circulation and cell stimulation of the tissue to be treated.
  • the at least one further effect parameter is generated by the applicator part itself, by a distal-side cap of the applicator part and / or a housing-fixed applicator holding part and coupled by this or this into the body.
  • the applicator part has at least one electrode which can be acted upon by current, this also including the case that the applicator part itself serves as an electrode, that the applicator part has a cap on the distal side, which has at least one electrode which can be acted upon by current , and / or that the at least one electrode is arranged in or on a housing head piece.
  • the electrode is preferably circular in shape in order to achieve a large-scale coupling of the current, which is, for example, a therapeutic alternating current, and thus a large-scale action on the body area to be treated.
  • the return current can be capacitive without a counter electrode, via a neutral electrode on the body of the patient or via a counter electrode on the device, for example on the applicator part or on the housing.
  • the device is equipped with a power supply source or connected to such, which acts on the at least one electrode with high-frequency current.
  • This embodiment is particularly advantageous in the treatment of cellulite or skin wrinkles with the device according to the invention, since the high frequency current collagen fibers can be heated until they shrink.
  • a high frequency current bipolar radio frequency current is preferably used when the skin is to be superficially heated for this purpose, until a shrinkage of the collagen fibers, and / or monopolar high frequency current is used, which achieves a greater depth effect and thus so far heated the tissue in depth until there is a shrinkage of collagen fibers.
  • the high frequency current preferably has a frequency in the range of about 0.5 MHz to about 50 MHz.
  • a high frequency of about 10 to about 50 MHz has the advantage that can be dispensed with the application of monopolar high-frequency current to a neutral electrode, which otherwise has to be applied to the body.
  • the electrode may be cooled, or in the application, the electrode is permanently moved.
  • the applicator part has at least one ultrasound emitter, and / or the applicator part has a cap on the distal side, which has at least one ultrasound emitter, and / or the at least one ultrasound emitter is arranged in or on a housing headpiece.
  • the at least one or more ultrasound emitters preferably define / define a circular emitter surface.
  • the at least one above-mentioned ultrasound emitter thus generates extracorporeal ultrasound, which is coupled into the body in addition to the mechanical pressure or shock waves, which are rather low-frequency, so that the low-frequency pressure or shock waves can be superimposed on the high-frequency ultrasound waves in the treatment area.
  • the applicator part has at least one light source, and / or the applicator part has a cap on the distal side, which has at least one light source, and / or at least one light source, which is selected from the group, is arranged in or on a housing head piece. which contains an LED, a laser or a laser LED.
  • the one or more light sources define / define a circular light emitting surface.
  • the light source may comprise a plurality of LEDs or laser LEDs, which may for example be arranged annularly in or on the applicator or on the cap of the applicator.
  • Such heating can advantageously be achieved by means of the applied light in that the at least one light source radiates infrared light.
  • the light source one or more infrared LEDs or infrared laser LEDs may be used for this purpose.
  • the infrared light as described above in connection with the application of high-frequency current, is able to achieve such heating of the skin or of the underlying tissue that collagen fibers shrink.
  • the temperatures required for this are in an estimated range of about 50 ° to about 80 ° C.
  • the aforementioned ultrasound emitter or aforementioned light sources are preferably arranged in or on the housing head piece of the device in the vicinity of the applicator, which means a lower cost in the maintenance of the device especially with replaceable applicator.
  • the housing head piece is preferably removable and preferably serves as an applicator holding part for holding it on the handpiece.
  • the impacts with which the proximal side of the applicator part can be repeatedly acted upon are effected by at least one impact part which is moved along an acceleration path ,
  • the impact member is made of a material of low specific weight, for example made of plastic or a light metal, for example made of titanium, aluminum or the like.
  • the impact member has a mass of less than 10 g, preferably less than 5 g, more preferably less than 3 g.
  • the design of the at least one impact member with low weight has the advantage that in contrast to the known device pulse frequencies or impact frequencies of more than 20 Hz can be achieved without it being necessary to increase, for example, the acceleration distance of the percussion part. As a result, the device remains handy, and it is not necessary in the case of a pneumatic drive of the striker to increase the pressure of the pneumatic actuator.
  • a higher pulse or impulse frequency has the advantage that resonances in the tissue to be treated can be stimulated more efficiently, such resonances further improving the therapeutic effect of the pressure or shock waves.
  • the impact part has recesses, cavities, depressions or openings.
  • the recesses, cavities, depressions or openings also lead to a weight reduction of the percussion part, without having to use a particularly light material such as those mentioned above for the production of the percussion part.
  • the impact member also made of a metal of higher density and higher hardness and thus more wear-resistant, eg. made of steel, wherein the recesses, cavities, depressions or openings then significantly reduce the mass of the percussion part.
  • the impact part is accelerated to an impact speed upon impact with the applicator part which is greater than 20 m / s.
  • a higher impact velocity of the impact part of more than 20 m / s which is not achieved in the known device, has the advantage that on the one hand, the pulse rate of the shock generation can be increased, and on the other hand, with the higher impact velocity despite the lower mass the striking part according to the aforementioned embodiments achieved a sufficiently high pressure wave energy in the applicator and thus after the coupling in the body area to be treated.
  • the impact part has a length that is substantially no longer than twice the diameter of the impact part.
  • the shortest possible embodiment of the percussion part in turn has the advantage of a smaller mass of the percussion part to achieve a higher pulse frequency, wherein a length which corresponds approximately to twice the diameter of the percussion part, advantageously avoids tilting or tilting of the percussion part on its acceleration section.
  • the impacts with which the proximal side of the applicator part is repeatedly acted upon are caused by at least two impact parts, which are each moved along an acceleration section.
  • the advantage of a pressure or shock wave generating mechanism with a plurality of impact parts is that the individual impact parts taken alone each can be performed with low mass without reducing the total impulse on the applicator.
  • the multiple impact parts thus cause a pulse gain at the same time low Schlagteilmasse and not extended acceleration section.
  • the impact parts can impinge on the applicator part substantially simultaneously in order to exert the highest possible total impulse on the applicator part, whereby pressure or shock waves with high energy can be generated, or the impact parts can also impinge on the applicator part one after the other, whereby the advantage of a higher Pulse frequency can be achieved.
  • the applicator part can be tilted out of its longitudinal axis, and the impact parts strike the applicator part outside the longitudinal axis.
  • the striking successively and outside of the longitudinal axis on the tilting of its longitudinal axis applicator impact members cause a tilting or wobbling movement of the applicator, depending on whether two impact parts or three or more impact parts are present.
  • the tilting or tumbling movement of the applicator part in addition to the coupling of the pressure or shock waves, causes a massaging effect on the tissue.
  • Fig. 1 is provided with the general reference numeral 10 medical device for the treatment of the human or animal body with mechanical pressure or shock waves.
  • the device 10 is used for example for pain therapy or generally for soft tissue treatment.
  • the device 10 generally includes a housing 12 having a proximal end 14 and a distal end 16.
  • the device 10 is in the form of a rod-shaped handpiece.
  • the device 10 has a device for generating pressure or shock waves, which has an applicator part 18 arranged at the distal end of the housing 12 in the distal head piece 16.
  • the headpiece 16 serves as an applicator holder for holding the applicator part 18 on the handpiece.
  • the applicator part 18 has a proximal entry surface 20 and a distal exit surface 22 for the pressure or shock waves. Via the entry surface 20, the pressure or shock waves are generated in the applicator 18.
  • a striking member 24 is disposed in the housing 12, which is in a longitudinal direction of the housing 12 extending guide tube 26 according to a double arrow 28 movable back and forth to repeatedly exert on the entrance surface 20 of the applicator 18 a shock.
  • the impact member 24 is moved by means of compressed air to the distal, for which a compressed air inlet 30 is disposed at the proximal end portion 14 of the housing 12, is introduced by the compressed air of an external compressed air source not shown in the guide tube 26 through an opening 32 of the same pulse-like manner, wherein the introduced compressed air a proximal surface 34 of the impact member 24 acts and thereby the impact member 24 is accelerated from a starting position at 36 to the applicator 18 out.
  • a pressure or shock wave is induced therein, which propagates through the applicator portion 18 to the exit surface 22 and exits therefrom to be coupled into the body of a patient.
  • the applicator member 18 performs only a minimum stroke with each impact of the impact member 24, the impact member 18 being resiliently constrained between a proximal elastomeric O-ring 38 and a distal elastomeric O-ring 40.
  • the applicator part On the other hand, however, 18 may also be mounted in such a way that it can execute a comparatively large stroke of up to 5 mm.
  • the device 10 is designed not only for the generation and coupling of mechanical pressure or shock waves, but it is in addition to the extracorporeal generation of at least one other physiological action parameter and coupling of the same formed in the human or animal body, the effect parameter is an electric current, electromagnetic waves, in particular light, ultrasound, and / or contains a further mechanical effect.
  • the at least one further effect parameter is generated by the applicator part 18 or by a cap 42 arranged on the distal exit surface 22 and / or by the housing head piece 16, in particular in a distal region thereof, and coupled into the body of a patient.
  • Fig. 2 1 shows an embodiment of the applicator part 18, in which the applicator part 18 has an electrode 44 which can be acted upon by current at its exit face 22.
  • the aforementioned cap 42 may include the electrode 44.
  • the electrode 44 is in particular of annular or disk-shaped design and, in the exemplary embodiment shown, has the shape of a circular ring. It may also be the entire applicator 18 or a part thereof itself formed as an electrode. As in Fig. 2 is also shown, additionally or alternatively, the housing head piece 16 may have an electrode 44 'or be designed as such itself.
  • a current in particular a therapeutic alternating current, can be injected into the body in the treatment area, so that the Overlay effect of mechanical pressure or shock waves and current in the treatment area.
  • a monopolar or bipolar high-frequency current can be injected into the body into the treatment area, which is able to heat the skin superficially or in depth to such an extent that collagen fibers shrink. This effect is particularly beneficial in the treatment of cellulite or wrinkles.
  • a power source 45 providing bipolar or monopolar high frequency current is shown in U.S. Patent No. 5,429,654 Fig. 1 shown schematically. The high frequency voltage is correspondingly applied to the electrode 44 and / or 44 '.
  • bipolar high-frequency current one of the two electrodes 44, 44 'can form the neutral electrode and the other of the two electrodes can form the active electrode. The current flow then takes place between these two electrodes with a low penetration into the skin.
  • one or both electrodes 44, 44 ' can each form the active electrode, while a neutral electrode, not shown, is applied to the patient's body, usually far away from the treatment site.
  • a neutral electrode not shown
  • such an additional neutral electrode can be dispensed with if the high-frequency current is applied at a high frequency, for example in the range from about 10 MHz to about 50 MHz.
  • the frequency of the high frequency current may generally be lower, for example in the range of about 0.5 to 4 MHz.
  • Fig. 3 shows an embodiment of the Applikatorteils 18, in which the applicator 18 has a plurality of light sources 46, which in addition to the mechanical pressure or shock waves light, especially therapeutic light, couple into the treatment area of the patient's body.
  • light sources 46 ' may be arranged on the housing head piece in or on the distal region 50.
  • the light sources 46 or 46 ' are preferably those emitting infrared light.
  • the infrared light like the above-mentioned high-frequency current, leads to tissue warming which has the effect of shrinking skin or collagen fibers, i. to cause at least partial denaturation of these fibers.
  • infrared LEDs or infrared laser LEDs may be used as the light sources 46 or 46 '.
  • the light sources 46 or 46 ' are arranged in a circle. Likewise, it is again possible to provide the light source or the light sources 46 on the cap 42.
  • Fig. 4 shows an embodiment of the applicator 18, in which on the exit surface 22 a plurality of ultrasonic emitters 48 are arranged.
  • the ultrasound emitters 48 generate ultrasound, which is then coupled by the ultrasound emitters 48 and the applicator 18 in addition to the mechanical pressure or shock waves in the body of the patient.
  • the ultrasound emitters 48 are arranged in a circular manner on the exit surface 22 of the applicator part 18, or define a circular ultrasound emission surface.
  • the ultrasound emitters 48 may in turn also be arranged on the cap 42, or the housing headpiece 16 may have ultrasound emitters 48 'in or on the distal region 50.
  • the applicator portion 18, the applicator cap 42 and / or the housing head piece 16 may comprise combinations of the electrode 44, the light sources 46 and / or the ultrasonic emitters 48.
  • the energy supply of these elements via sliding contacts can be made inductively or capacitively.
  • the impact member 24 is made of a material of low specific gravity. Such a material may in particular be plastic or a light metal, for example titanium, aluminum or the like. By using a material of low specific weight, the impact part 24 has a low mass, so that the impact part 24 impacts the entry surface 20 of the applicator part 18 without increasing the acceleration distance in the guide tube 26 at a high speed of more than 20 m / s.
  • the mass of the impact member 24 is preferably less than 10 g, preferably less than 5 g, more preferably less than 3 g.
  • the mass of the impact member 24 can be further reduced by 24 recesses, cavities, depressions or openings are provided in the impact member, the impact member 24 may have, for example in the simplest case, a continuous or blind longitudinal bore, so that the impact member 24 in total or is partially sleeve-shaped.
  • the openings may also be formed in the direction transverse to the longitudinal direction of the percussion part 24 in this.
  • the impact member 24 is not tilted in the guide tube 26, its length in the direction of the double arrow 28 is greater than or equal to twice its diameter in the direction transverse to the double arrow 28, wherein the length of the impact member 24 is preferably approximately equal to twice its diameter.
  • FIG. 5 and 6 Further embodiments of a medical device for treating the human or animal body with mechanical pressure or shock waves are described.
  • Fig. 5 shows a medical device 60 with a housing 62 and an applicator 64 for generating and coupling pressure or shock waves in the human or animal body.
  • Applicator portion 64 may include one or more of the embodiments of FIG Fig. 2 to 4 to which reference is made to the above description.
  • the device 60 has a device for generating pressure or shock waves, which has two impact parts 66 and 68 in addition to the applicator part 64.
  • the impact part 66 corresponds to the impact part 24 in FIG Fig. 1 , wherein the impact member 66 is moved in a guide tube 70 back and forth, the guide tube 26 in Fig. 1 equivalent.
  • the impact member 68 is in the embodiment shown in FIG Fig. 5 formed as an annular sleeve, which is arranged concentrically around the impact member 66 around, and is moved in a guide tube 72 back and forth, which concentrically surrounds the guide tube 70 and is formed as a cylindrical tube.
  • the impact member 66 and 68 are pressurized via compressed air lines 74 and 76 with corresponding control valves 78 and 80 so that the impact members 66 and 68 impinge simultaneously on the applicator 64. So that the impact parts 66 and 68 are accelerated synchronously, their masses are matched or the pressure of the air or gas with which the impact parts 66 and 68 acted impulsively proximal, is matched to the two impact parts 66 and 68 accordingly.
  • a medical device 90 for treating the human or animal body with mechanical shock or shock waves having a housing 92 and at the distal end an applicator portion 94.
  • the device 90 has a device for generating pressure or shock waves, which has three or four impact parts 96, 98 and 100.
  • the impact member 96 is in a guide tube 102, the impact member 98 in a guide tube 104 and the impact member 100 in a guide tube 106 movable back and forth.
  • the guide tube 102 is pressurized via a pressure feed line 108 with control valve 110, the guide tube 104 via a pressure feed line 112 with control valve 114 and the guide tube 106 via a pressure feed line 116 with control valve 118 to the respective impact member 96, 98 and 100 from a proximal starting position to the applicator 94 to accelerate.
  • the applicator part 94 in the housing 92 is tiltably mounted relative to a longitudinal central axis 120 of the applicator part 94, as illustrated by a double arrow 122.
  • the impact parts 96, 98, 100 and the guide tubes 102, 104, 106 are eccentrically arranged with respect to the longitudinal central axis 120, so that the impact parts 96, 98, 100 impact on the applicator 94 outside the longitudinal center axis 120 and a corresponding tilting of the Applicator 94 with respect to the longitudinal central axis 120 cause.
  • the applicator parts 96, 98, 100 or the guide tubes 102, 104, 106 can be arranged around the longitudinal center axis 120 at an angular distance of 120 ° from each other. It is also possible to provide four or more impact parts, which are arranged correspondingly in an angular distribution of 90 ° or a corresponding angular distribution about the longitudinal central axis 120, so that they each impact the striking part 94 off-center.
  • control valves 110, 114, 118 in the pressure supply lines 108, 112, 116 are clocked accordingly to make the impact members 96, 98, 100 individually and successively impact the applicator 94.
  • applicator part 94 may additionally be provided according to one or more of the embodiments in FIG Fig. 2 to 4 be designed.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Optics & Photonics (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Ophthalmology & Optometry (AREA)
  • Vascular Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Electromagnetism (AREA)
  • Otolaryngology (AREA)
  • Mechanical Engineering (AREA)
  • Plastic & Reconstructive Surgery (AREA)
  • Radiology & Medical Imaging (AREA)
  • Dentistry (AREA)
  • Surgical Instruments (AREA)
  • Percussion Or Vibration Massage (AREA)

Claims (12)

  1. Appareil médical servant à traiter le corps d'un être humain ou d'un animal avec des ondes de pression ou de choc mécaniques, comprenant un dispositif servant à produire des ondes de pression ou de choc, lequel présente au moins une partie d'applicateur (18 ; 64 ; 94), qui peut être soumise à l'action de chocs sur un côté proximal afin de produire les ondes de pression ou de choc et qui injecte dans le corps les ondes de pression ou de choc sur un côté distal, caractérisé en ce que l'appareil (10 ; 60 ; 90) est réalisé en supplément afin de produire de manière extracorporelle au moins un autre paramètre d'action physiologique servant à traiter le corps d'un être humain ou d'un animal et afin d'injecter de manière combinée ce dernier avec les ondes de pression ou de choc dans le corps, lequel paramètre d'action est choisi parmi le groupe contenant un courant électrique, une lumière et/ou un ultrason, dans lequel l'appareil présente :
    - au moins une électrode (44, 44') pouvant être soumise à l'action d'un courant et une source d'alimentation en tension, qui soumet l'au moins une électrode (44, 44') à l'action d'un courant à fréquence élevée monopolaire ou bipolaire, dans lequel le courant à fréquence élevée présente une fréquence située dans la plage allant d'environ 0,5 MHz à environ 50 MHz, et/ou
    - au moins un émetteur d'ultrasons (48, 48'), dans lequel l'émetteur d'ultrasons (48, 48') émet des ultrasons à haute fréquence, tandis que les ondes de pression ou de choc sont à basse fréquence, et/ou
    - au moins une source de lumière (46, 46'), qui est choisie parmi le groupe contenant une DEL, un laser, une DEL à laser, dans lequel l'au moins une source de lumière (46, 46') est une source de lumière émettant une lumière infrarouge.
  2. Appareil selon la revendication 1, caractérisé en ce que l'au moins une partie d'applicateur (18) est elle-même réalisée sous la forme de l'électrode (44, 44') pouvant être soumise à l'action du courant.
  3. Appareil selon la revendication 1 ou 2, caractérisé en ce que la partie d'applicateur (18) présente un capuchon (42) disposé côté distal au niveau de la partie d'applicateur (18) ou une pièce de tête de boîtier (16), l'au moins une électrode (44, 44'), l'au moins un émetteur d'ultrasons (48, 48') et/ou l'au moins une source de lumière (46, 46').
  4. Appareil selon l'une quelconque des revendications 1 à 3, caractérisé en ce que l'au moins une électrode (44, 44') est de forme circulaire, et/ou que l'au moins un ou les nombreux émetteurs d'ultrasons (48, 48') définit/définissent une surface d'émission de forme circulaire, et/ou que l'au moins une source de lumière ou les nombreuses sources de lumière (46, 46') définit/définissent une surface d'émission de lumière de forme circulaire.
  5. Appareil selon l'une quelconque des revendications 1 à 4, caractérisé en ce que les chocs, à l'action desquels le côté proximal de la partie d'applicateur (18) peut être soumis de manière répétée, sont provoqués par au moins une partie de percussion (24 ; 66, 68 ; 96, 98, 100), qui est déplacée le long d'un tronçon d'accélération.
  6. Appareil selon la revendication 5, caractérisé en ce que la partie de percussion (24; 66, 68; 96, 98, 100) est fabriquée à partir d'un matériau présentant un faible poids spécifique, par exemple à partir de matière plastique ou d'un métal léger, par exemple à partir de titane, d'aluminium ou similaire.
  7. Appareil selon la revendication 5 ou 6, caractérisé en ce que la partie de percussion (24 ; 66, 68 ; 96, 98, 100) présente des évidements, des cavités, des renfoncements ou des ouvertures.
  8. Appareil selon l'une quelconque des revendications 5 à 7, caractérisé en ce que la partie de percussion (24 ; 66, 68 ; 96, 98, 100) est accélérée à une vitesse d'impact lors de l'impact sur la partie d'applicateur, laquelle est supérieure à 20 m/s.
  9. Appareil selon l'une quelconque des revendications 5 à 8, caractérisé en ce que les coups, à l'action desquels le côté proximal de la partie d'applicateur peut être soumis de manière répétée, sont provoqués par au moins deux parties de percussion (66, 68 ; 96, 98, 100), qui sont déplacées le long respectivement d'un tronçon d'accélération.
  10. Appareil selon la revendication 9, caractérisé en ce que les parties de percussion (66, 68) viennent heurter la partie d'applicateur sensiblement de manière simultanée.
  11. Appareil selon la revendication 9, caractérisé en ce que les parties de percussion (96, 98, 100) viennent heurter les unes après les autres la partie d'applicateur.
  12. Appareil selon la revendication 11, caractérisé en ce que la partie d'applicateur (94) peut être basculée à partir de son axe médian longitudinal (120), et que les parties de percussion (96, 98, 100) viennent heurter la partie d'applicateur (94) à l'extérieur de l'axe médian longitudinal (120).
EP08758527.9A 2007-05-31 2008-05-15 Appareil médical pour traiter le corps d'un être humain ou d'un animal avec des ondes de pression ou des ondes de choc mécaniques Active EP2166963B1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE202007007920U DE202007007920U1 (de) 2007-05-31 2007-05-31 Medizinisches Gerät zur Behandlung des menschlichen oder tierischen Körpers
PCT/EP2008/003883 WO2008145260A2 (fr) 2007-05-31 2008-05-15 Appareil médical pour traiter le corps d'un être humain ou d'un animal avec des ondes de pression ou des ondes de choc mécaniques

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EP2166963A2 EP2166963A2 (fr) 2010-03-31
EP2166963B1 true EP2166963B1 (fr) 2017-11-08

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US (1) US20100137752A1 (fr)
EP (1) EP2166963B1 (fr)
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WO2008145260A2 (fr) 2008-12-04
EP2166963A2 (fr) 2010-03-31
US20100137752A1 (en) 2010-06-03
DE202007007920U1 (de) 2008-10-09
WO2008145260A3 (fr) 2009-04-16

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